Diabetic retinopathy is symptomless until it is advanced, and good vision does not exclude sight-threatening disease. Every adult with type 2 diabetes should have a dilated retinal examination or validated retinal photography at diagnosis, and regularly afterwards, with the interval set by the findings.
Refer promptly for reduced vision, macular oedema, or proliferative or severe non-proliferative retinopathy. Pregnancy, rapid HbA1c reduction and kidney disease are times to look sooner.
- Examine the retina with dilation or validated photography at diabetes diagnosis.
- Repeat at an interval set by the grade of retinopathy found.
- Normal vision does not exclude sight-threatening retinopathy.
- Look sooner in pregnancy and after rapid improvement in glucose control.
Why it matters
In community screening, half of some groups already had retinopathy, much of it unknown to them.
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